Shared decision‐making among people with problematic alcohol/other drug use and co‐occurring mental health conditions: a systematic review

Alana Fisher*, Katherine Mills, Maree Teesson, Christina Marel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Introduction and Aims
Over half of people presenting to alcohol/other drug (AOD) treatment services also have a mental health condition. Guidelines support numerous viable treatment options, meaning that treatment decisions need to be evidence based and patients' preferences need to be considered. Shared decision‐making (SDM) facilitates evidence‐ and preference‐based decisions and is well researched in other health‐care areas. Little is known, however, about people's attitudes towards and experience of SDM in co‐occurring AOD and mental health conditions.

Design and Methods
Systematic literature review via key database searches MEDLINE, EMBASE, PsycINFO, Scopus, the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (January 2000–July 2019). Two independent reviewers assessed study eligibility, extracted data and rated study quality using a validated tool.

Results
Of 2393 articles identified, 10 studies were retained for final inclusion. The reviewed studies suggested that SDM is a well‐accepted and preferred approach to treatment decision‐making. SDM‐based interventions are viewed as feasible, acceptable and useful; are associated with improvements in the quality of the decision‐making process and the decision made; and have accrued less consistent evidence to support improvements in patient‐related outcomes (e.g. symptoms, treatment adherence/engagement).

Discussion and Conclusions
This is the first rigorous synthesis of the empirical literature on SDM in co‐occurring AOD and mental health conditions. SDM remains a nascent area of research in comorbidity treatment. Preliminary evidence supports SDM's acceptability, feasibility and utility in managing mental health and AOD comorbidities. Further research is needed to build the evidence base, especially with regard to the efficacy of SDM at improving patient‐related outcomes.
Original languageEnglish
Pages (from-to)307-324
Number of pages18
JournalDrug and Alcohol Review
Volume40
Issue number2
DOIs
Publication statusPublished - 9 Feb 2021
Externally publishedYes

Keywords

  • substance-related disorders
  • mental disorders
  • patient participation
  • decision-making
  • systematic review

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